Abstract Details

Title Anticoagulation and Risk of Cognitive Decline in Patients with Atrial Fibrillation: An Umbrella Review of Meta-analyses

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 13-014

Objective To synthesize meta-analytic evidence on the association between oral anticoagulant therapy and cognitive outcomes in patients with atrial fibrillation, and to evaluate whether non–vitamin K oral anticoagulants confer greater protection against dementia than vitamin K antagonists.

Background Atrial fibrillation (AF) increases the risk of cognitive decline and dementia through thromboembolic and microvascular mechanisms. Oral anticoagulants (OACs), including vitamin K antagonists (VKAs) and non-vitamin K oral anticoagulants (NOACs), may mitigate these risks. This umbrella review synthesizes meta-analytic evidence evaluating the cognitive effects of anticoagulation in AF.

Design/Methods Following PRIOR guidelines, PubMed, Scopus, Web of Science, and Google Scholar were searched up to April 2025 for systematic reviews with quantitative synthesis assessing the association between OAC use and cognitive outcomes in AF. Extracted data included pooled relative risks (RRs) or hazard ratios (HRs) with 95% confidence intervals (CIs) and heterogeneity (I²). Methodological rigor was evaluated using the AMSTAR-2 tool.

Results Across five meta-analyses, anticoagulation was consistently associated with reduced cognitive decline or dementia in AF. Zeng 2019 reported a protective effect for OAC versus no OAC (RR 0.72, 95% CI 0.69–0.75; I²=11.5%), persisting after stroke/TIA adjustment (RR 0.72; 0.69–0.74). Kernan 2020 found a similar benefit (HR 0.79; 0.68–0.92), and Wang 2023 confirmed reduced dementia incidence with anticoagulation (HR 0.80; 0.72–0.89; I²=49%). Head-to-head comparisons demonstrated a modest advantage for NOACs over VKAs: Moffitt 2022 (HR 0.86; 0.80–0.93; I²=47%) and Zhou 2021 (HR 0.87; 0.79–0.96; I²=54%). Overall, findings showed consistent cognitive benefit with OACs, especially NOACs.

Conclusions Meta-analytic evidence supports a protective association between oral anticoagulation and cognitive outcomes in AF. NOACs appear to provide a slightly greater reduction in dementia risk compared with VKAs. Future longitudinal and randomized studies should confirm causality and refine optimal therapeutic strategies for neuroprotection.

Authors/Disclosures
Mahjabin Shahid, Jr., MD PRESENTER	Dr. Shahid has nothing to disclose.
Humaira Sadat Sultany, MD	Dr. Sadat Sultany has nothing to disclose.
Nafisa Hamidi, MD	Dr. Hamidi has nothing to disclose.
Hashmat U. Faizi, MD	Mr. Faizi has nothing to disclose.
Sayed Sahil Hashemi, MD	Dr. Hashemi has nothing to disclose.

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